Labor Complications

7.3% of people giving birth will experience some type of labor or delivery complication. Labor and delivery complications during childbirth can include premature labor, fetal distress, failure to progress, cord prolapse, shoulder dystocia, and postpartum hemorrhage. In this article, we’ll discuss what these are and how these issues are handled.

Premature Labor

The normal length of pregnancy is 37 to 42 weeks. A baby born before 37 weeks is called premature or preterm. This can be further broken up in the three following categories: 

• Extremely preterm: Less than 28 weeks 
• Very preterm: 28- 31 weeks 
• Late preterm: 32-37 weeks 

Not much is known about why preterm labor occurs for the most part. Most occur randomly while others can be triggered by things like infections, placenta abnormalities, or maternal complications threatening the mother’s life such as preeclampsia. 

There are not many treatments for preterm labor so prevention is key, which starts with encouraging a healthy pregnancy and regular prenatal care. Sometimes, medications called tocolytics can be given to delay birth and stop labor. 

Fetal Distress

During labor, the baby is monitored for signs of distress, which can indicate that the baby's oxygen supply is reduced. This monitoring is usually done with a fetal heart monitor that can be placed on the mother’s stomach or inserted vaginally. One sign of fetal distress is meconium-stained water (meconium is the baby's first dark green bowel movement). 

However, this alone doesn't always indicate fetal distress, but if it's combined with a slowing of the baby's heart rate, fetal distress is more likely and steps may be taken for a prompt delivery. If there is thick meconium in the water, there is a danger that the baby could inhale meconium at birth, which can lead to breathing problems and lung infection. 

Other signs of fetal distress include: 

• Abnormal heart rate, especially slower heart rate
• Decreased fetal movement
• Maternal cramping, especially if severe
• Vaginal bleeding 

Sometimes, the treatment for the distress is simple such as changing position or drinking some water. Other treatment options include giving oxygen to the mother to increase oxygenation to the placenta, give intravenous infusions for extra hydration, medications to stop or slow contractions to put less stress on the fetus, an amnioinfusion where fluids are injected into the amniotic sac, and in serious situation, an emergency caesarean may be done. 

Failure to Progress

Sometimes the cervix fails to dilate as expected during the first stage of labor, which is called a failure to progress during labor. There are several factors that can hamper the progress of labor: the baby's head may be too large for the pelvis; there may be inefficient contractions; or the baby may not be in the right position. 

The best thing to do if there is no fetal distress is to relax and wait. This is also called the latent phase of labor and can last longer for some people. Walking, sleeping, taking a warm bath, and stopping any medications that may pause labor can also be done. In serious situations, such as maternal or fetal distress, or if labor persists longer than the mother can tolerate, a caesarean may be done. 

Cord Prolapse

The fetus is attached to the placenta by the umbilical cord, a long cord of veins and arteries that supplies the fetus with oxygenated blood. 

Rarely, the umbilical cord lies below the baby and closer to the cervix. This is more likely in a breech birth (feet first), or where the baby lies in a transverse position (sideways). 

In these cases, when the water breaks, the cord can slip through the cervix, which is also called prolapse. This is an emergency because the cord may be compressed and restrict or cut off the baby's oxygen supply, causing fetal distress and can lead to fetal death if not addressed immediately. 

Unless an immediate assisted vaginal delivery is possible, an emergency cesarean will be done.

Shoulder Dystocia

Shoulder dystocia is when the baby's head is born, but the shoulders remain stuck so the body. It's more common if the baby is big or if the mother has diabetes.

If the head is delivered, and there are signs that the rest of the baby is not coming easily, the mother's legs can be lifted up to help the baby's shoulders down and an episiotomy may be done. This is a small incision to make the vaginal opening larger, allowing the baby’s shoulders to pass through. 

If the baby still doesn't come easily, there are maneuvers the doctor will do to help release the shoulders and aid the delivery. This can also include forceps and vacuum assisted delivery and in serious situations, emergency cesarean. 

Postpartum Hemorrhage

Postpartum hemorrhage occurs when a woman loses more than 1 pint (500 ml) of blood within 24 hours of birth. This can be during delivery or in the first 24 hours postpartum. 

It can be due to the uterus not contracting quickly enough allowing the arteries and veins to open longer, an incomplete delivery of the placenta, or vaginal tears. Factors that increase the risk include a large baby or twins; prolonged labor; or bleeding before the labor 

Active management in the delivery of the placenta makes it less likely to happen. It's often possible to control bleeding with drugs to help the uterus contract, closing the arteries and veins and preventing them from bleeding heavily, or by correcting problems such as retained bits of placenta, and suturing tears. If bleeding continues, arteries that supply blood to the uterus may be closed off surgically and you may also need a blood transfusion to replace lost blood.

While labor and delivery complications are common, knowing how to respond, how they may be treated, and what to expect, can help you be as prepared as possible.